Social inequalities in mortality in a retrospective cohort of civil servants in Barcelona

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Abstract
Background The objective of this study is to describe the inequalities in mortality by occupational category and sex in a retrospective cohort of civil servants working in the city council of Barcelona (Spain). Methods The cohort was followed for the period 1984–1993. There were 11 647 men and 9001 women. Age-adjusted hazard ratios (HR) of death for occupational categories and manual versus non-manual groups and 95% CI were derived from Cox proportional hazards models. Results For total deaths in males, compared with high-level professionals, auxiliary workers (HR = 1.30, 95% CI: 0.96–1.77), skilled manual workers (HR = 1.29, 95% CI: 0.95–1.77), unskilled manual workers (HR = 1.46, 95% CI: 1.07–1.98) and police and fire manual workers (HR = 1.42, 95% CI: 1.08–1.87) had higher risk of death. Among women, for all causes of mortality, only police manual workers had higher mortality (HR = 5.63, 95% CI: 1.89–16.7) whereas auxiliary workers had the lowest HR (HR = 0.51, 95% CI: 0.25–1.05). The HR comparing manual and non-manual categories for all causes of death was 1.29 for males (95% CI: 1.09–1.52) and 1.07 for females (95% CI: 0.77–1.49). Among males, whereas manual workers had lower cardiovascular mortality (HR = 0.85, 95% CI: 0.63–1.15), cancer mortality was higher in the manual category. No association between manual category and mortality was found among women. Conclusions This study provides an analysis of social inequalities in mortality in a cohort from a Southern European urban area.